Mori Teizaburo, Yamada Yohei, Abe Kiyotomo, Takahashi Nobuhiro, Kano Motohiro, Fujimura Takumi, Watanabe Toshihiko, Nakatsuka Seishi, Hoshino Ken, Kuroda Tatsuo
1 Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
2 Department of Pediatric Surgery, Tokai University School of Medicine, Kanagawa, Japan.
J Laparoendosc Adv Surg Tech A. 2019 Apr;29(4):573-578. doi: 10.1089/lap.2018.0581. Epub 2019 Jan 7.
Extrahepatic congenital portosystemic shunts (CPSSs) can be occluded by surgical or endovascular approaches. However, when the estimated portal vein (PV) pressure after the closure is high enough to induce symptoms associated with portal hypertension, partial closure is recommended to avoid life-threatening events. In this study, we attempted laparoscopic partial closure of a CPSS in two patients. Along with intraoperative real-time measuring of the PV pressure and angiography, laparoscopic partial closure was performed to achieve a PV pressure of ≤25 mmHg. Subsequently, the intrahepatic portal system grew in both patients. The partially ligated CPSS closed spontaneously in the first patient. In the second patient, laparoscopic complete closure was performed for the residual CPSS 6 months after the first operation. To our knowledge, this is the first report of laparoscopic partial closure for CPSS. Minimally invasive laparoscopic partial ligation of CPSS is technically feasible and useful when the estimated PV pressure is too high to tolerate one-step complete closure.
肝外先天性门体分流（CPSS）可通过手术或血管内方法进行闭塞。然而，当闭合后门静脉（PV）压力估计高到足以诱发与门静脉高压相关的症状时，建议进行部分闭合以避免危及生命的事件。在本研究中，我们尝试对两名患者进行腹腔镜下CPSS部分闭合术。在术中实时测量PV压力并进行血管造影的同时，进行腹腔镜部分闭合以实现PV压力≤25 mmHg。随后，两名患者的肝内门静脉系统均有所增长。在第一名患者中，部分结扎的CPSS自行闭合。在第二名患者中，在首次手术后6个月对残余的CPSS进行了腹腔镜完全闭合术。据我们所知，这是首例关于CPSS腹腔镜部分闭合术的报告。当估计的PV压力过高而无法耐受一步完全闭合时，微创腹腔镜下CPSS部分结扎在技术上是可行且有用的。
